Tobacco use remains the leading cause of preventable death and disease in the United States and in Wyoming. To address this enormous toll, the American Lung Association in Wyoming calls for the following actions to be taken by our elected officials:

Support and implement a $1.00 increase in the tobacco tax;

Increase/maintain funding for tobacco prevention and cessation programs; and

Adopt a statewide, comprehensive smokefree law.

Budget and revenue shortfalls once again forced the Wyoming legislature to make difficult decisions. Despite the best efforts of public health advocates, the legislature cut a total of $2.1 million in tobacco prevention and cessation dollars over the fiscal year 2018 and fiscal year 2019 biennium. This reduction eliminated the Quitline-Quitnet, an online and telephone resource to assist people to eliminate their tobacco addiction.

An increase in the tobacco tax was proposed during the 2017 legislative session. Unfortunately, the increase was only 30 cents, which would not be large enough to yield the reduction in youth and adult smoking that the American Lung Association in Wyoming supports. The legislation gained some traction, but was ultimately not passed.

In December 2017, the Joint Revenue committee in the Wyoming legislature voted 8-7 to introduce a $1.00 increase in the state's tobacco tax, with an equal tax applied to all other tobacco products during the 2018 legislative session. This increase would be expected to generate approximately $22 million in new revenue. The American Lung Association in Wyoming will support this proposal and work to see that a portion of the new revenue is dedicated to support tobacco prevention and cessation programs.

Wyoming Facts

Economic Cost Due to Smoking:

$257,674,019

Adult Smoking Rate:

18.90%

Adult Tobacco Use Rate:

25.60%

High School Smoking Rate:

15.70%

High School Tobacco Use Rate:

38.40%

Middle School Smoking Rate:

5.40%

Smoking Attributable Deaths:

800

Adult smoking and tobacco use data come from CDC's 2016 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use data come from the 2015 Youth Risk Behavior Surveillance System. Middle school smoking rate is taken from the Wyoming 2013 Youth Risk Behavior Surveillance System.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.

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Tobacco use remains the leading cause of preventable death and disease in the United States and in Wisconsin. To address this enormous toll, the American Lung Association in Wisconsin calls for the following actions to be taken by our elected officials:

Pass legislation that places ALL tobacco products behind the counter or in a locked cabinet;

Lay the groundwork for future passage of Tobacco 21 legislation; and

Pass legislation requiring all school districts to have a comprehensive e-cigarette policy that prohibits use on school grounds.

Wisconsin's biennial budget was finally passed more than two months late in 2017, which meant meaningful work on moving tobacco control policies forward was delayed. The budget itself contained good and bad elements for tobacco control – on a positive note, funding for the Wisconsin Tobacco Prevention and Control program was maintained with no cuts, but for the third time, the legislature refused to include a tax increase for little cigars, which would have brought the tax on them up to par with cigarettes. This is due to the very strong anti-tax mentality that presently exists in the legislature.

While progress might be stalled on the state level, local activity continued at a brisk pace as city and county officials passed ordinances to add e-cigarettes to their smokefree air ordinances and school boards adopted policies prohibiting e-cigarette use on school grounds. On the smokefree outdoor air front, tobacco and smokefree (including e-cigarettes) parks are starting to gain acceptance and become more prevalent.

In August, the Wisconsin Department of Health and Family Services released its findings from the Youth Tobacco Survey, demonstrating a continued drop in youth smoking rates. Middle and high school smoking rates are at historic lows, 1.3 percent and 8.1 percent respectively. However, use of e-cigarettes by youth is skyrocketing, from 7.9 percent to 13.3 percent in Wisconsin's high schools. The influence and appeal of candy and fruit flavors is unquestionable – 89.9 percent of high schoolers "think they probably would not, or definitely would not try an e-cigarette if it did not have any flavor such as mint, candy, fruit or chocolate."

Clearly the impact flavorings have on youth is huge, which makes it even more important that these products not be easily accessible to anyone under age 18. Retail assessments conducted throughout the state in 2017 have documented their placement alongside candy and snacks where they are easily stolen, and even very young children can "browse" them.

While the American Lung Association in Wisconsin will continue to work with local tobacco control coalitions to strengthen community tobacco control ordinances, the most sweeping progress is still made at the state level. The Lung Association will focus on passing legislation that requires that ALL tobacco sales be clerk assisted, continue to educate lawmakers and the public on the health benefits of raising the legal sales age for tobacco to 21 and fight for strong clean air policies, both indoors and out.

Wisconsin Facts

Economic Cost Due to Smoking:

$2,663,227,988

Adult Smoking Rate:

17.10%

Adult Tobacco Use Rate:

19.90%

High School Smoking Rate:

8.10%

High School Tobacco Use Rate:

12.50%

Middle School Smoking Rate:

1.30%

Smoking Attributable Deaths:

7,850

Adult smoking and tobacco use data come from CDC's 2016 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use and middle school smoking rates are taken from the 2016 Youth Tobacco Survey.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.

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Tobacco use remains the leading cause of preventable death and disease in the United States and in West Virginia. To address this enormous toll, the American Lung Association in West Virginia calls for the following actions to be taken by our elected officials:

Restoration of West Virginia state funding for tobacco prevention and cessation;

Protect clean indoor air regulations as they currently exist throughout the state; and

Increase tobacco excise tax to be in line with the national average.

During the 2017 Legislative Session, three different attempts to preempt clean indoor air regulations in the state were fought off. Luckily, none of the bills made it past the first committee.

A bill introduced by Senator Stollings, to raise the minimum tobacco sales age to 21, failed in the Senate Health committee.

Other bills that failed, were an attempt to pass a bill that would not allow drivers to smoke in a motor vehicle if they had a passenger under the age of 16 with them; and legislation that would have allowed employers, such as health care providers, to not hire smokers. Neither of these bills made it out of the Senate Health Committee, their committee of origin.

Most alarmingly, in order to cut West Virginia spending by more than $100 million for the 2017-18 budget, legislators completely defunded the state Division of Tobacco Prevention. This move effectively eliminated all West Virginia state tobacco cessation and prevention efforts – even though the federal Centers for Disease Control and Prevention for years has cited the state for spending only a fraction of the amount it needs to spend to effectively combat tobacco-related illnesses. This is particularly disappointing given West Virginia has one of the highest smoking rates in the country, which costs the state over $1 billion in healthcare costs and lost productivity each year.

In 2018, new leadership and direction for the Coalition for Tobacco Free West Virginia will be needed – with an emphasis on information sharing, collaboration throughout the state and local support. A strong state coalition will be necessary to help sustain/reinstate tobacco control funding and programs. This can be done by making the coalition more representative of the community, which can hopefully help develop more public support for the services provided by the state Division of Tobacco Prevention. The coalition will also need to expose the tobacco industry's deceptive, predatory, and deadly practices by developing more effective methods to counter their strategies.

West Virginia Facts

Economic Cost Due to Smoking:

$1,008,474,499

Adult Smoking Rate:

24.80%

Adult Tobacco Use Rate:

31.30%

High School Smoking Rate:

16.20%

High School Tobacco Use Rate:

40.80%

Middle School Smoking Rate:

4.60%

Smoking Attributable Deaths:

4,280

Adult smoking and tobacco use data come from CDC's 2016 Behavioral Risk Factor Surveillance System. High school and middle school smoking rates are taken from the 2015 Youth Tobacco Survey. High school tobacco use rate is taken from the 2015 Youth Risk Behavior Surveillance System.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.

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Tobacco use remains the leading cause of preventable death and disease in the United States and in Washington. To address this enormous toll, the American Lung Association in Washington calls for the following actions to be taken by our elected officials:

Raise the minimum legal sale age for tobacco products to 21 years of age;

Increase funding for tobacco prevention and cessation programs; and

Maintain the comprehensive smokefree air law.

Washington's 2017 legislative session was the longest session in history as three full special sessions were called. The largest task before the legislature was funding basic education to meet the State Supreme Court's ruling on the McCleary court case. The political divisions within the legislature provided additional challenges. This was also reflected in the small numbers of bills that were sent to the Governor for signature.

House Bill 1054 and Senate Bill 5024 proposed raising the minimum legal sale age for tobacco products to 21 years. After a successful hearing in the House, the bill moved to the House Rules committee where it remained throughout the session. The Senate version of the bill was referred to the Senate Commerce/Labor/Sports committee and didn't receive a hearing. This legislation has a large coalition supporting and lobbying for its passage. The legislation was requested by the State Attorney General and the Department of Health.

With the legislature facing budget challenges, the lost revenue resulting from this bill was one of the consistent and convincing arguments for proponents. The Governor's budget proposed $15.9 million for the estimated revenue loss.

Securing additional funding for tobacco prevention and cessation remains a priority goal for the American Lung Association in Washington. While no additional cuts were made to the state program, no additional funding was secured either leaving Washington with a meager $1.4 million in state funding for tobacco prevention and cessation.

Once again, legislation was introduced to establish special licensing for cigar lounges and retail tobacconist shops. House Bill 1919 was referred to the House Health Care and Wellness committee; it did not receive a hearing.

The American Lung Association in Washington will continue its support of policies to reduce the harmful effects of tobacco on Washingtonians. The coalition working on Tobacco 21 continues to grow. The coalition is focusing efforts on engaging youth in supporting and lobbying for this legislation. With additional grassroots support, the American Lung Association in Washington hopes to join together with the other states who have already passed Tobacco 21 laws.

Washington Facts

Economic Cost Due to Smoking:

$2,811,911,987

Adult Smoking Rate:

13.90%

Adult Tobacco Use Rate:

16.40%

High School Smoking Rate:

6.30%

High School Tobacco Use Rate:

N/A

Middle School Smoking Rate:

3.10%

Smoking Attributable Deaths:

8,290

Adult smoking and tobacco use data come from CDC's 2016 Behavioral Risk Factor Surveillance System. High school (10th grade only) and middle school (8th grade only) smoking rates are taken from the 2016 Washington State Healthy Youth Survey. A current high school tobacco use rate is not available for this state.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.

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Tobacco use remains the leading cause of preventable death and disease in the United States and in Virginia. To address this enormous toll, the American Lung Association in Virginia calls for the following actions to be taken by our elected officials:

Increase the cigarette excise tax by at least $1.00 per pack;

Create parity between taxes on cigarettes and other tobacco products; and

Fund tobacco prevention and cessation programs at the Centers for Disease Control and Prevention (CDC)-recommended level.

In the 2017 legislative session, a bill was introduced which would allow all localities to impose a cigarette tax by removing the requirement that only those localities that had such authority prior to 1977 are eligible. The bill would have set a maximum rate on the cigarette tax imposed by counties of five cents per pack or the amount levied under state law, whichever is greater. The bill was left in the Senate Finance Committee.

Bills to authorize any county to impose a tax on cigarettes were also introduced in the House and state Senate. Again, both were left in their respective Finance Committees and died.

The American Lung Association in Virginia led efforts to urge the Pharmacy and Therapeutics Committee to give a favorable review for Medicaid coverage of benefits consistent with CDC recommendations and Virginia law, including FDA-approved pharmacotherapy products.

Several bills dealing with electronic cigarettes were also introduced in 2017, including a bill that would authorize cities and towns and certain counties to impose a tax on vapor products. The state tax rate is $0.05 per fluid milliliter of consumable vapor product and 10 percent of the retail price for electronic cigarettes or similar products or devices. The bill required revenues from the state tax on vapor products to be deposited into the Virginia Tobacco Settlement Fund. The bill was left in the Finance Committee and died at the end of the session.

In 2018, priorities for the American Lung Association in Virginia will include working to ensure prevention and cessation programs are funded, an increase in the cigarette excise tax, and parity between taxes on cigarettes and other tobacco products.

Virginia Facts

Economic Cost Due to Smoking:

$3,113,009,298

Adult Smoking Rate:

15.30%

Adult Tobacco Use Rate:

18.00%

High School Smoking Rate:

8.20%

High School Tobacco Use Rate:

22.70%

Middle School Smoking Rate:

1.60%

Smoking Attributable Deaths:

10,310

Adult smoking and tobacco use data come from CDC's 2016 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use data come from the 2015 Youth Risk Behavior Surveillance System. Middle school smoking rate is taken from the Virginia 2015 Youth Risk Behavior Surveillance System.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.

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Tobacco use remains the leading cause of preventable death and disease in the United States and in Vermont. To address this enormous toll, the American Lung Association in Vermont calls for the following actions to be taken by our elected officials:

Increase fiscal year 2019 funding for Vermont's comprehensive tobacco control program to $3.8 million;

Raise the legal age for sale of tobacco products to 21; and

Require landlords to disclose smoking policies in building to prospective renters.

2017 marks the least productive year in Vermont's Legislature in the fight against tobacco use. It's the first time in years that a significant tobacco control bill was not passed. In addition, the Governor proposed to cut most of the budget for the Tobacco Evaluation and Review Board which oversees the independent evaluation of the tobacco control program. The final fiscal year 2018 budget included no appropriation for the Board. This cut threatens the future of the Board and ultimately, the effectiveness of the comprehensive tobacco control program.

The Coalition for a Tobacco Free Vermont ran a comprehensive campaign in support of a Senate bill to raise the legal age of the sale of tobacco to 21. In spite of the backing of the Majority Leader and a 5-0 vote from the Senate Health and Welfare Committee, the bill failed 13-16 on the Senate floor. While this was a loss for champion legislators and advocates, it was more of a loss for Vermont teens and young adults. Ninety-five percent of adults started smoking by the age of 21 and half of them became regular smokers by their 19th birthday. Lawmakers missed an opportunity to pass a measure to help to protect Vermont's youth from a lifetime of addiction to tobacco.

Fortunately, the state health department, working with local tobacco control and prevention grantees, is addressing the smoking rate among young adults through the Vermont Tobacco-Free Colleges Initiative. Eighteen percent of Vermonters between the ages of 18 and 24 smoke. By the fall of 2019, the percent of college students covered by a tobacco-free college campus policy will increase from 34 percent to 76 percent, thanks to a resolution passed by the Vermont State College Chancellors. The resolution commits to making all five Vermont State College campuses tobacco-free by the fall of 2019.

The American Lung Association in Vermont will continue to work with coalition partners, the American Heart Association, and the American Cancer Society Cancer Action Network to advance tobacco control efforts and protect Vermont's tobacco control program. The Lung Association will continue to educate policy makers, business leaders and the media about the importance of raising the age of tobacco sales to 21 as well as other Lung Association goals to reduce tobacco use and protect public health.

Vermont Facts

Economic Cost Due to Smoking:

$348,112,248

Adult Smoking Rate:

17.00%

Adult Tobacco Use Rate:

18.70%

High School Smoking Rate:

10.80%

High School Tobacco Use Rate:

24.70%

Middle School Smoking Rate:

2.00%

Smoking Attributable Deaths:

960

Adult smoking and tobacco use data come from CDC's 2016 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use data come from the 2015 Youth Risk Behavior Surveillance System. Middle school smoking rate is taken from the Vermont 2015 Youth Risk Behavior Surveillance System. Results are rounded to the nearest whole number.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.

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Tobacco use remains the leading cause of preventable death and disease in the United States and in Utah. To address this enormous toll, the American Lung Association in Utah calls for the following actions to be taken by our elected officials:

Maintain or increase funding for state's tobacco prevention and control program;

Increase the minimum legal sales age for tobacco products to 21; and

Raise Utah's tobacco tax to encourage an even further reduction in tobacco use.

In 2017, the American Lung Association in Utah supported legislation that would have increased the age to legally purchase tobacco products to 21 years of age from age 19 currently. Although the legislation did not make it out committee, legislators were educated on the issue for when the bill is introduced in future legislative sessions.

The Lung Association also opposed a bill introduced in the state House of Representatives that would have removed a sunset clause for several exemptions in Utah's Clean Indoor Air Act that prohibited smoking in virtually all public places and workplaces. The bill did pass the first committee in the House, but luckily did not advance any further.

Funding for the Utah Tobacco Prevention and Control Program at the state Department of Health was again maintained at about the same level as previous years in fiscal year 2018. The program is funded by a combination of tobacco Master Settlement Agreement dollars and tobacco tax revenue.

In 2018, the American Lung Association in Utah will continue pushing to increase the sales age for tobacco products to 21, and to maintain or even increase funding for the Utah Tobacco Prevention and Control Program.

Utah Facts

Economic Cost Due to Smoking:

$542,335,526

Adult Smoking Rate:

8.80%

Adult Tobacco Use Rate:

11.10%

High School Smoking Rate:

4.40%

High School Tobacco Use Rate:

N/A

Middle School Smoking Rate:

N/A

Smoking Attributable Deaths:

1,340

Adult smoking and tobacco use data come from CDC's 2016 Behavioral Risk Factor Surveillance System. High school smoking rate is taken from the 2013 Youth Risk Behavior Surveillance System. Current high school tobacco use and middle school smoking rates are not available for this state.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.

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Tobacco use remains the leading cause of preventable death and disease in the United States and in Texas. To address this enormous toll, the American Lung Association in Texas calls for the following actions to be taken by our elected officials:

Restore funding for tobacco prevention and cessation programs that was significantly cut in years 2018 and 2019;

Continue to pass comprehensive local smokefree ordinances to builds towards a statewide smokefree law; and

Increasing the minimum legal sales age for tobacco products to 21.

The American Lung Association in Texas along with our partners at Smoke-Free Texas provides leadership and guidance for public policy efforts to continue the state's success in reducing the impact of tobacco among Texans. Together with our partners, the American Lung Association in Texas works to ensure tobacco control and prevention remains a priority for state legislators and local decision makers.

During the 2017 legislative session, the American Lung Association along with our partners of the Texas 21 Coalition supported legislation increasing the minimum age of sale for tobacco products to 21 years old. House Bill 190 passed the House Committee on Public Health but failed to get additional committee hearings. On the local level, the city of San Antonio was considering passage of a local Tobacco 21 ordinance when this report went to press.

The Lung Association in partnership with the Texas Cancer Partnership coalition worked to extend the sunset review date for the Cancer Prevention & Research Institute of Texas (CPRIT) by two years. This allows the agency to fully invest $3 billion in cancer prevention programs and research.

Significant progress continued to be made in 2017 on passing smokefree ordinances at the local level. Fort Worth, the largest metro area in Texas without a comprehensive smokefree ordinance previously, passed an ordinance that prohibits smoking in virtually all public places and workplaces in December 2017. This was a multi-year effort by tobacco control advocates, including the Lung Association, and a significant step forward. Another large city, Arlington, also passed a mostly comprehensive smokefree law in 2017, but disappointingly included exemptions for e-cigarettes and bingo halls. Texas currently has 88 cities that have passed comprehensive smokefree ordinances protecting more than 12.4 million citizens from the harmful effects of secondhand smoke.

The Texas Legislature only meets in odd numbered years, so moving forward in 2018, the Lung Association and its partners in the Smoke-Free Texas coalition will work in communities around the state to pass, and in some cases strengthen existing, local smokefree ordinances. The Lung Association will also look for opportunities to advance Tobacco 21 at the local level in Texas.

Texas Facts

Economic Cost Due to Smoking:

$8,855,602,443

Adult Smoking Rate:

14.30%

Adult Tobacco Use Rate:

17.20%

High School Smoking Rate:

7.80%

High School Tobacco Use Rate:

N/A

Middle School Smoking Rate:

2.40%

Smoking Attributable Deaths:

28,030

Adult smoking and tobacco use data come from CDC's 2016 Behavioral Risk Factor Surveillance System. High school (11th grade only) and middle school (8th grade only) smoking rates are taken from the 2016 Texas School Survey. A current high school tobacco use rate is not available for this state.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.

Tobacco use remains the leading cause of preventable death and disease in the United States and in Tennessee. To address this enormous toll, the American Lung Association in Tennessee calls for the following actions to be taken by our elected officials:

Increase the tobacco tax by $1.00 per pack or more;

Repeal preemption to allow local communities to pass stronger smokefree ordinances; and

Unfortunately, the 2017 legislative session saw few victories against tobacco. The city of Cookeville was given the authority by the state legislature to prohibit smoking at Dogwood Park. Also, public universities in Tennessee were given the authority to create their own tobacco use policies. There were two bills that sought to give local governments more power regarding tobacco, both received broad support and were sent to a summer study committee in hopes of combining the two. No other tobacco bills were heard before committees in 2017.

The American Lung Association in Tennessee with partners is working to raise the price of cigarettes by $1.00 per pack or more, repeal preemption to allow local communities to pass stronger smokefree laws and pass legislation or regulations making all U.S. Food and Drug Administration and U.S. Preventive Services Task Force approved tobacco cessation interventions covered by Medicaid with no barriers. This is being accomplished by mobilizing grassroots support across the state and strengthening our state tobacco control coalition to include more organizations. Tennessee began restructuring and recruitment of the coalition with a planning committee to set goals in October 2017.

Tennessee Facts

Economic Cost Due to Smoking:

$2,672,824,085

Adult Smoking Rate:

22.10%

Adult Tobacco Use Rate:

26.80%

High School Smoking Rate:

11.50%

High School Tobacco Use Rate:

31.90%

Middle School Smoking Rate:

N/A

Smoking Attributable Deaths:

11,380

Adult smoking and tobacco use data come from CDC's 2016 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use data come from the 2015 Youth Risk Behavior Surveillance System. A current middle school smoking rate is not available for this state.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.

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Tobacco use remains the leading cause of preventable death and disease in the United States and in South Dakota. To address this enormous toll, the American Lung Association in South Dakota calls for the following actions to be taken by our elected officials:

Increase the tax on cigarettes and other tobacco products;

Raise the age of sale for all tobacco products to 21 years old; and

Protect South Dakota's comprehensive smokefree workplace law.

The South Dakota Department of Health along with national, state, and local partners continue to work together on implementation of the five-year tobacco strategic plan. The four goal areas of the plan include: preventing initiation of tobacco use, promoting quitting among adults and youth, eliminating exposure to secondhand smoke and identifying and eliminating tobacco-related disparities among population groups. Priority populations include: American Indians, Medicaid enrollees, pregnant women, people with mental illness and substance use disorders, spit tobacco users, and youth and young adults.

During the 2017 legislative session, the Speaker of the House of Representatives submitted a proposal to the Secretary of State that would increase the tobacco tax by $1.00 per pack via a ballot initiative with part of the revenues dedicated to lower technical school tuition and provide scholarships along with funding tobacco prevention and awareness programs. If the adequate number of signatures are collected, the question of raising the tobacco tax will be on the ballot in November 2018.

The coalition in South Dakota, including the American Lung Association in South Dakota, has strong roots across the state and is working together to support tobacco control best practices and continues to work together to implement the strategic plan to reduce the harm from tobacco in South Dakota.

South Dakota Facts

Economic Cost Due to Smoking:

$373,112,273

Adult Smoking Rate:

18.10%

Adult Tobacco Use Rate:

22.60%

High School Smoking Rate:

10.10%

High School Tobacco Use Rate:

30.30%

Middle School Smoking Rate:

2.80%

Smoking Attributable Deaths:

1,250

Adult smoking and tobacco use data come from CDC's 2015 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use data come from the 2015 Youth Risk Behavior Surveillance System. Middle school smoking rate is taken from the 2016 Youth Tobacco Survey.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.

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Tobacco use remains the leading cause of preventable death and disease in the United States and in South Carolina. To address this enormous toll, the American Lung Association in South Carolina calls for the following three actions to be taken by our elected officials:

Increase the price of tobacco products to reduce tobacco use among youth and adults;

Increase the number of comprehensive local smokefree air laws; and

Increase funding for the state's tobacco prevention program.

South Carolina took a major step forward in reducing tobacco use with the increase in tobacco cessation coverage for Medicaid beneficiaries. As of July 1, 2017, the South Carolina Department of Health and Human Services (SC DHHS) enhanced tobacco cessation coverage for full-benefit Medicaid beneficiaries to align with recommendations from the Centers for Disease Control and Prevention and the American Lung Association. SC DHHS and the SC Department of Health and Environmental Control (DHEC) worked together to craft a plan to benefit both fee-for-service and managed care Medicaid benefits.

The new policy provides tobacco cessation medications without prior authorization or co-payment; provides one-on-one telephone and web-based counseling to Medicaid beneficiaries without charge through the SC Tobacco Quitline; strongly encourages Medicaid prescribers and pharmacists to refer patients to the Quitline at 1-800-QUIT-NOW; and covers tobacco cessation counseling in individual and group settings when billed with the allowable CPT codes.The plan has truly made South Carolina a leader in this arena.

The American Lung Association in South Carolina and partners in the South Carolina Tobacco-Free Collaborative continue to support passage of smokefree air ordinances at the local level. The state has 62 local comprehensive smokefree ordinances covering about 40 percent of the state's population. State funding for DHEC's Tobacco Prevention and Control programs remained at $5 million in fiscal year 2018. The program receives all of its state funding from cigarette tax revenues.

The American Lung Association joined many organizations under the umbrella of the South Carolina Tobacco-Free Collaborative to urge consideration of a significant increase in the state's 57-cent cigarette tax with comparable increases for other tobacco products. Price increases from the 2010 tax increase led to appreciable reductions in youth smoking in South Carolina. The 2013 South Carolina Youth Tobacco Survey found that between 2011 and 2013, cigarette use among high school students fell from 23.7 percent to 15.4 percent.

The American Lung Association will continue to advocate for comprehensive smokefree air ordinances, improvements in quit smoking benefits for workers, increased tobacco taxes and increasing the $5 million-dollar allocation in state tobacco prevention funding.

South Carolina Facts

Economic Cost Due to Smoking:

$1,906,984,487

Adult Smoking Rate:

20.00%

Adult Tobacco Use Rate:

22.80%

High School Smoking Rate:

9.60%

High School Tobacco Use Rate:

29.10%

Middle School Smoking Rate:

4.80%

Smoking Attributable Deaths:

7,230

Adult smoking and tobacco use data come from CDC's 2016 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use data come from the 2015 Youth Risk Behavior Surveillance System. Middle school smoking rate is taken from the 2013 South Carolina Youth Tobacco Survey.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.

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Tobacco use remains the leading cause of preventable death and disease in the United States and in Rhode Island. To address this enormous toll, the American Lung Association in Rhode Island calls for the following actions to be taken by our elected officials:

Raise the minimum age of sale for tobacco products from 18 to 21;

Increase funding to the Rhode Island Department of Health's tobacco control program; and

Increase the amount of local tobacco retail ordinances on: raising the age to 21, retailer licensing, flavor restrictions, product placement and couponing/promotions restrictions.

The 2017 Rhode Island legislative session included one victory: the passage of legislation which prohibits the use of ENDS (electronic nicotine delivery systems) products in schools and prohibits the sale of ENDS liquid that's not contained in child-resistant packaging. This bill was signed by Governor Raimondo in October 2017 and took effect January 1, 2018.

Other tobacco bills that were introduced, but not passed included: adding electronic cigarettes to the Rhode Island smokefree workplace law, adding sales and use taxes to ENDS products and little cigars, raising the minimum age of sale for tobacco products from 18 to 21, not allowing smoking in Rhode Island casinos and several smokefree multi-unit housing safety acts.

The proposed fiscal year 2018 budget from Governor Raimondo included a 50-cent cigarette tax increase and providing passage, a $500,000 dedication to tobacco control programs. As in previous years, health advocates including the American Lung Association in Rhode Island, were opposed due to the resulting price increase being too small to impact youth and adult smoking rates. The requested excise tax was passed raising the tax from $3.75 to $4.25 per pack, however funding dedicated to tobacco control programs was not included making the increase even less effective.

Additionally, on the local level, there were numerous victories, many of which were supported by the Lung Association and Tobacco Free RI. The City of Woonsocket and Town of Bristol both strengthened existing outdoor smokefree ordinances to include ENDS products. The Town of Barrington raised the legal minimum age of sale for tobacco products from 18 to 21. The Cities of Woonsocket and West Warwick and the Towns of Barrington, Johnston and Middletown, adopted comprehensive tobacco control regulations which included requiring local tobacco retail licensing, tobacco enforcement funding, flavored tobacco product restrictions and some of which included the elimination of tobacco discounts and promotions. Several other Rhode Island cities and towns considered similar regulations which are expected to gain traction in 2018.

The American Lung Association in Rhode Island will build on positive hearings in 2017 and support legislation that raises the age of sale for tobacco products to 21; increases funding for the state's tobacco control program; and strengthens point of sale tobacco regulations. Strong public support exists for these measures, which the Lung Association will seek to publicize and leverage with state legislators and policy makers.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.

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Tobacco use remains the leading cause of preventable death and disease in the United States and in Pennsylvania. To address this enormous toll, the American Lung Association in Pennsylvania calls for the following actions to be taken by our elected officials:

Support a Youth Tobacco Prevention Package to include;

Increase funding for tobacco prevention and cessation programs;

Increase the licensure fee to sell tobacco products;

Increase the age of sale for tobacco products to age 21; and

Remove the exemptions from the current Clean Indoor Air Act that restricts smoking in public places and workplaces.

The 2017 legislative session brought the introduction of a Tobacco 21 bill. Senator Mario Scavello introduced a model bill that would raise the minimum legal sale age of tobacco products to 21. The announcement of Tobacco 21 bill came the same day as over 500 American Lung Association advocates attended an event at the State Capitol to demand a Tobacco 21 bill.

In 2017, the Pennsylvania Tobacco Prevention and Control Program (PATPC) focused on several types of collaborations to maximize new opportunities and sustain core tobacco control work. Collaborations occurred at the state and local levels, in addition to many PATPC presentations to national audiences. In 2017, PATPC worked closely with those implementing the new HUD smokefree regulations and continued clean air work with worksites and healthcare facilities not covered by the current clean indoor air law. PATPC also worked with the Department of Corrections to use findings from an initial pilot study to inform draft guidance for offering cessation in state correction institutions. PATPC continues to prioritize prevention, clean air policy, cessation, and addressing health disparities both on stand alone and collective efforts.

In a positive development, the Allegheny County Council passed a local ordinance that prohibits the use of e-cigarettes in the same places where smoking is prohibited by state law. Allegheny County includes the city of Pittsburgh.

The American Lung Association in Pennsylvania will continue to educate lawmakers on the ongoing fight against tobacco. Our goal is to build champions within the legislature and a groundswell of advocates to advance our goals: to support a youth tobacco prevention package that increases funding for tobacco prevention and cessation programs, increases the license fee to sell tobacco products, and increases the sales age for tobacco products to 21. The Lung Association will also continue to work to remove the exemptions from the current clean indoor air law.

Pennsylvania Facts

Economic Cost Due to Smoking:

$6,383,194,368

Adult Smoking Rate:

18.00%

Adult Tobacco Use Rate:

20.30%

High School Smoking Rate:

10.30%

High School Tobacco Use Rate:

32.30%

Middle School Smoking Rate:

1.30%

Smoking Attributable Deaths:

22,010

Adult smoking and tobacco use data come from CDC's 2016 Behavioral Risk Factor Surveillance System. High school and middle school smoking rates are taken from the 2015 Youth Tobacco Survey. High school tobacco use rate is taken from the 2015 Youth Risk Behavior Surveillance System.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.

Tobacco use remains the leading cause of preventable death and disease in the United States and in Oregon. To address this enormous toll, the American Lung Association in Oregon calls for the following actions to be taken by our elected officials:

Raise tobacco taxes with a portion of the new revenue dedicated to tobacco prevention and cessation programs;

During the 2017 legislative session, the American Lung Association in Oregon's main focus was Senate Bill 754, which proposed raising the minimum sales age for all tobacco products to 21 years old. Senator Elizabeth Steiner Hayward championed this legislation that had the support of many public health and other organizations. Oregon youth engaged and testified in support of this legislation, and spoke at a press conference where Gov. Kate Brown spoke in support of this policy. Senate Bill 754 passed both houses with bi-partisan support and was signed by Governor Brown on August 9, 2017. The law took effect on January 1, 2018. The American Lung Association in Oregon is pleased to have Oregon join four other states in taking this additional step to protect youth from purchasing tobacco products.

Oregon's successful Tobacco Prevention and Education Program received a $3.6 million cut to its program over the next two years, despite advocates fighting for maintaining current funding levels. The Tobacco Reduction Advisory committee is working on strategies to minimize the public health effect of this significant reduction.

Several other tobacco policy bills were introduced during the 2017 session. Several bills were introduced to raise tobacco taxes, after an increase was included in Governor Brown's proposed state budget. While the legislature is generally supportive of raising the cigarette tax, the Lung Association and partners were unable to move a successful increase through the legislative process. Taxation of electronic smoking devices, tobacco retail licensure and removing preemption were also unsuccessful.

The American Lung Association in Oregon joins together with the Oregon Healthy Authority and partners to celebrate the 10th anniversary of Oregon's Indoor Clean Air Act. The legislature passed comprehensive smokefree protections in 2007 and the law continues to protect the health of Oregonians and reduces the number of residents affected by secondhand smoke.

The American Lung Association in Oregon will continue to support policies and legislation to improve the health of the state. During the short thirty-day legislative session in 2018, tobacco prevention advocates will continue to educate legislators on the benefits of increasing tobacco taxes and adequately funding tobacco prevention and cessation programs.

Oregon Facts

Economic Cost Due to Smoking:

$1,547,762,592

Adult Smoking Rate:

16.20%

Adult Tobacco Use Rate:

19.20%

High School Smoking Rate:

8.80%

High School Tobacco Use Rate:

23.70%

Middle School Smoking Rate:

4.30%

Smoking Attributable Deaths:

5,470

Adult smoking and tobacco use data come from CDC's 2016 Behavioral Risk Factor Surveillance System. High school (11th grade only) smoking and tobacco use and middle school (8th grade only) smoking rates are taken from the 2015 Oregon Healthy Teens Survey.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.

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Tobacco use remains the leading cause of preventable death and disease in the United States and in Oklahoma. To address this enormous toll, the American Lung Association in Oklahoma calls for the following actions to be taken by our elected officials:

Pass a comprehensive statewide smokefree law that protects all workers and patrons from secondhand smoke.

During the 2017 legislative session, the American Lung Association along with our partners worked to increase the price of cigarettes by $1.50 per pack. The bill was passed by the legislature and enacted by Gov. Mary Fallin. However, the Oklahoma Supreme Court later in 2017 ruled the increase, which had been called a fee and passed by a simple majority, unconstitutional. Revenue-raising bills in Oklahoma have to meet several special requirements, including being supported by three-quarters of members in each house of the state legislature. An increase in price would provide big benefits to the state, including preventing nearly 32,000 Oklahoma kids from starting to smoke, prompting nearly as many adults to quit and preventing approximately 18,000 tobacco-related deaths.

Dedicated funding from the tobacco Master Settlement Agreement (MSA) for the Oklahoma Tobacco Settlement Endowment Trust (TSET) remained intact for fiscal year 2018. Oklahoma voters made a wise decision by putting 75 percent of MSA payments each year into TSET, and the Lung Association will oppose any attempts to raid these funds by the legislature.

Program initiatives of TSET and the Oklahoma Department of Health to prevent and reduce tobacco use include the Oklahoma Tobacco Helpline at 1-800-QUIT-NOW, cessation systems grants, community grants covering over 85 percent of the state's population, funding for tribal nations and other priority populations and statewide media campaigns intended to change the social norms related to tobacco use.

In 2018, the American Lung Association in Oklahoma, along with public health partners, will continue to raise public awareness regarding the need for a comprehensive statewide smokefree law. We will continue to support legislation that would increase the price cigarette by a $1.50 per pack, and continue to protect funding for TSET and the Oklahoma Department of Health.

Oklahoma Facts

Economic Cost Due to Smoking:

$1,622,429,589

Adult Smoking Rate:

19.60%

Adult Tobacco Use Rate:

23.80%

High School Smoking Rate:

13.10%

High School Tobacco Use Rate:

31.40%

Middle School Smoking Rate:

4.10%

Smoking Attributable Deaths:

7,490

Adult smoking and tobacco use data come from CDC's 2016 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use data come from the 2015 Youth Risk Behavior Surveillance System. Middle school smoking rate is taken from the 2016 Youth Tobacco Survey.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.

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Tobacco use remains the leading cause of preventable death and disease in the United States and in Ohio. To address this enormous toll, the American Lung Association in Ohio calls for the following actions to be taken by our elected officials:

Pass Tobacco 21 laws to increase the minimum age of sale for tobacco products to 21 in additional cities in the state;

Match the tax on non-cigarette forms of tobacco like spit tobacco, cigars and hookah to the cigarette tax; and

Increase funding for tobacco prevention and cessation programs.

During the 2017 legislative session, Governor Kasich proposed a 60-cent increase in the tax on cigarettes and other tobacco products. The American Lung Association in Ohio and a broad coalition of partners encouraged the legislature to go even higher and raise the tax by at least $1.00 per pack. Unfortunately, the proposal did not gain much traction in the legislature and an increase in tobacco taxes was not included in the final state budget that was adopted.

The legislature also proposed drastic cuts to funding for tobacco cessation and prevention programs in Ohio. The Lung Association and partners worked to restore those cuts and funding was ultimately maintained at $12.5 million a year.

While increasing the taxes on cigarettes may not be likely to happen in 2018, the Lung Association will continue to work with our partners to call for parity for taxes on non-cigarette forms of tobacco like spit tobacco, cigars, and e-cigs. These tobacco products attract younger, more price sensitive consumers and raising taxes on these products to achieve parity with cigarette taxes can prevent some kids from becoming addicted in the first place.

The Lung Association worked with coalitions and other interested parties around the state to help move their cities closer to passing laws to increase the minimum sales age for tobacco products to 21 often referred to as Tobacco 21 laws. In June of 2017, the City of Powell became the 8th community in Ohio to pass a Tobacco 21 law. Numerous other cities, such as Cincinnati, Dayton, Delaware, Dublin and Toledo are working towards enacting their own local Tobacco 21 ordinances.

As we look to 2018, the American Lung Association in Ohio will continue to work with a broad coalition of stakeholders to fully fund evidence-based tobacco prevention and cessation programs and pass Tobacco 21 laws in Ohio's cities.

Ohio Facts

Economic Cost Due to Smoking:

$5,647,310,236

Adult Smoking Rate:

22.50%

Adult Tobacco Use Rate:

25.70%

High School Smoking Rate:

15.10%

High School Tobacco Use Rate:

N/A

Middle School Smoking Rate:

2.60%

Smoking Attributable Deaths:

20,180

Adult smoking and tobacco use data come from CDC's 2016 Behavioral Risk Factor Surveillance System. High school smoking rate is taken from the 2013 Youth Risk Behavior Surveillance System. Middle school smoking rate is taken from the 2014 Youth Tobacco Survey. A current high school tobacco use rate is not available for this state.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.

Tobacco use remains the leading cause of preventable death and disease in the United States and in North Dakota. To address this enormous toll, the American Lung Association in North Dakota calls for the following actions to be taken by our elected officials.

Raise the state tobacco tax currently among the nation's lowest at 44 cents per pack;

Raise the age of sale for all tobacco products to 21 years old; and

Replace the dollars taken from the fully-funded state tobacco control program.

The North Dakota Center for Tobacco Prevention and Control Policy was formed as a result of an initiated measure in 2008, requiring that a portion of the funds that the state received from the tobacco Master Settlement Agreement be dedicated to reducing tobacco use utilizing proven tobacco control strategies. During the 2017 Legislative session the Center was dismantled and tobacco control funding reduced, no longer meeting the Centers for Disease Control and Prevention's standard of a "fully funded" program.

The American Lung Association in North Dakota worked hard to educate decision makers on the results that had been achieved over the lifespan of the Center, including a dramatic reduction in youth tobacco use rates, smooth implementation and compliance with the statewide smokefree law, and school tobacco-free policies across the state. The Lung Association emphasized that a vote of the people is a strong statement of support and should be honored, including keeping the tobacco control program fully funded. The legislative action resulted in substantial cuts to the once fully funded program, along with administration of the program put under the state Department of Health.

The Lung Association has worked in raising the awareness of the toll of tobacco on those with mental illness and/or substance use disorders for several years, educating providers on the need to address tobacco use. One highlight of the 2017 legislative session was the Scope of Practice for licensed addiction counselors in North Dakota being expanded to include treatment for nicotine addiction. It is hoped this will result in more patients with mental illness or substance use disorders being asked about their tobacco use, advised to quit and assisted with such effort.

The American Lung Association in North Dakota will continue to educate both state and local decisions makers on the need to increase the price of tobacco products, the benefits of an increase, along with increasing the sales age for tobacco products to 21.

North Dakota Facts

Economic Cost Due to Smoking:

$325,798,988

Adult Smoking Rate:

19.80%

Adult Tobacco Use Rate:

24.30%

High School Smoking Rate:

11.70%

High School Tobacco Use Rate:

31.10%

Middle School Smoking Rate:

3.60%

Smoking Attributable Deaths:

980

Adult smoking and tobacco use data come from CDC's 2016 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use data come from the 2015 Youth Risk Behavior Surveillance System. Middle school smoking rate is taken from the 2015 Youth Tobacco Survey.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.

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Tobacco use remains the leading cause of preventable death and disease in the United States and in North Carolina. To address this enormous toll, the American Lung Association in North Carolina calls for the following actions to be taken by our elected officials:

Restore funding for tobacco use prevention and cessation programs, including QuitlineNC;

Increase the state cigarette tax by at least $1.00 per pack; and

Resist attempts to weaken the smokefree restaurants and bars law and expand the law to include all public places and private worksites.

The American Lung Association has identified restoration of funding for the state's tobacco use prevention and cessation programs as the number one prerequisite to improving the health of North Carolinians. In 2017, the North Carolina General Assembly added funding for the state's tobacco use prevention and cessation program. While funding levels remain far from the $17.3 million the tobacco use prevention and cessation programs received in 2011 and before, these new funds are badly needed and much appreciated.

QuitlineNC, the state's phone counseling service for tobacco users, received an additional $250,000 in state funding in fiscal year 2018 to add to its $1.1 million. Demand for Quitline services is great. In previous years the Quitline had to cut back on services to avoid shutting down before the end of the fiscal year. $500,000 in new funds were provided to the state's tobacco prevention program, and $250,000 in funding was again allocated for You Quit, Two Quit, a program to screen and treat tobacco use in women of reproductive age, pregnant and postpartum mothers. All together, tobacco use prevention and cessation initiatives received $2.1 million in state funding for fiscal year 2018.

The American Lung Association in North Carolina will continue to partner with the North Carolina Alliance for Health as it defends against any threats or attempts to weaken the smokefree restaurants and bars law and seeks options for strengthening protections for nonsmokers. An increase in North Carolina's 45-cent cigarette tax is overdue and should be a significant increase. Price increases of $1.00 per pack or more have repeatedly been shown to reduce youth and adult smoking rates. The Lung Association in North Carolina, along with other partners, will continue to emphasize increased funding for tobacco use prevention programs and for QuitlineNC.

North Carolina Facts

Economic Cost Due to Smoking:

$3,809,676,476

Adult Smoking Rate:

17.90%

Adult Tobacco Use Rate:

21.10%

High School Smoking Rate:

9.30%

High School Tobacco Use Rate:

27.50%

Middle School Smoking Rate:

2.30%

Smoking Attributable Deaths:

14,220

Adult smoking and tobacco use data come from CDC's 2016 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use and middle school smoking rates are taken from the 2015 North Carolina Youth Tobacco Survey.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.

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Tobacco use remains the leading cause of preventable death and disease in the United States and in New York. To address this enormous toll, the American Lung Association in New York calls for the following actions to be taken by our elected officials:

Raise the age of sale for tobacco products to 21;

Restore funding to New York's Tobacco Control Program; and

Expand the amount of smokefree spaces in New York.

2017 was an interesting year for tobacco control in New York State. The state Senate recognized the necessity to close the "loop-hole" and joined the Assembly in voting to include electronic cigarettes in the state Clean Indoor Air Act. The bill was then signed into law by Governor Cuomo in October. This means that the use of electronic cigarettes are now be prohibited indoors, like traditional smoked tobacco products. A bill was also passed to require the registration of electronic cigarette vendors with the Department of Taxation and Finance. This bill was vetoed by the Governor. On the budget side, this year we saw level-funding for tobacco control at $39.3 million and no new tobacco taxes enacted.

There continued to be significant progress on the local level on Tobacco 21 legislation. We saw many counties pass legislation which prohibits the sale of tobacco to those under the age of 21, and now more than 50 percent of New Yorkers are now covered by local Tobacco 21 laws. Additionally, we saw the passage of a comprehensive package of tobacco control legislation in New York City, which among other things, prohibited the sale of tobacco in pharmacies, reduced the number of tobacco licenses available to retailers, increased the minimum price of tobacco products and expanded smokefree housing.

Our local tobacco coalitions, funded by the state Department of Health, continue to educate communities about the importance of limiting point of sale advertising by restricting the number, location and/or type of retailers that sell tobacco products. As a result of these efforts, Rockland County recently became the first county in New York to prohibit the sale of tobacco in pharmacies. Other initiatives include working with communities to develop tobacco free outdoor policies and smoke free multi-unit housing.

In 2018, it is imperative that the state increase funding for the state tobacco control program. The lack of funding has had a direct impact on the ability to fight tobacco use disparities that continue to exist in certain areas and populations across our state. Increased funding will allow for interventions targeted to specific populations that have smoking rates that are double or triple the rest of the population.

The American Lung Association in New York will also push for legislation that prohibits the sale of tobacco products to those under age 21. Additionally, we will continue to pursue comprehensive smokefree laws to expand the number of smokefree spaces in New York. New York has a long history of leading on tobacco control efforts, it is time for decision-makers to take decisive action to save lives. The status quo will not suffice.

New York Facts

Economic Cost Due to Smoking:

$10,389,849,268

Adult Smoking Rate:

14.20%

Adult Tobacco Use Rate:

15.60%

High School Smoking Rate:

4.30%

High School Tobacco Use Rate:

25.40%

Middle School Smoking Rate:

1.20%

Smoking Attributable Deaths:

28,170

Adult smoking and tobacco use data come from CDC's 2016 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use data come from the 2016 New York Youth Tobacco Survey. Middle school smoking rate is taken from the New York 2014 Youth Tobacco Survey.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.

Tobacco use remains the leading cause of preventable death and disease in the United States and in New Mexico. To address this enormous toll, the American Lung Association in New Mexico calls for the following actions to be taken by our elected officials:

Raise the tax on cigarettes and other tobacco products including snuff, chewing tobacco and cigars/cigarillos;

Maintain or increase funding for state's tobacco prevention and control program; and

Protect New Mexicans from secondhand smoke exposure, including in multi-unit housing.

The American Lung Association in New Mexico provides leadership in convening partners and guiding public policy efforts to continue the state's success in reducing the impact of tobacco among New Mexicans. Together with our partners, the American Lung Association in New Mexico works to ensure tobacco control and prevention remains a priority for state legislators and local decision makers.

In 2017, our focus was to continue to educate legislators, legislative staff, and the general public about smoking and the importance of providing tobacco cessation programs for adults and youth, and the dangers of secondhand smoke. During the legislative session, the Lung Association along with our partners were unsuccessful in passing legislation to raise the state's cigarette tax by $1.50 per pack and impose an equivalent tax on other tobacco products including cigars, smokeless tobacco and electronic cigarettes. The legislation would have generated an estimated $31.66 million in new revenue for the state of New Mexico while dramatically reducing adult and youth tobacco use rates.

The American Lung Association in New Mexico's Smoke-Free at Home NM program provides education and support to property managers and owners on the economic and health benefits of implementing smokefree policies in multi-unit housing. In 2017, the Lung Association continued to help public, affordable, and market rate housing implement smokefree policies building on our efforts from previous years. Smoke-Free at Home NM certified seven properties as smokefree representing 554 units and approximately 1,354 residents, while an additional 15 properties implemented our Thinking About Quitting workshops helping smokers who were interested in quitting.

Moving forward in 2018, the American Lung Association in New Mexico will once again make it a priority to educate our legislature and communities about the dangers of tobacco use and the importance of a well-funded tobacco prevention and cessation program. Additionally, we will be working on raising the excise tax on tobacco products. The American Lung Association in New Mexico will also continue to focus on creating smokefree multi-unit housing. It is our goal to provide all New Mexicans with a safe and healthy living environment, free from the dangers of secondhand smoke.

New Mexico Facts

Economic Cost Due to Smoking:

$843,869,235

Adult Smoking Rate:

16.60%

Adult Tobacco Use Rate:

19.40%

High School Smoking Rate:

11.40%

High School Tobacco Use Rate:

32.20%

Middle School Smoking Rate:

N/A

Smoking Attributable Deaths:

2,630

Adult smoking and tobacco use data come from CDC's 2016 Behavioral Risk Factor Surveillance System. High school smoking and tobacco use data come from the 2015 Youth Risk Behavior Surveillance System. A current middle school smoking rate is not available for this state.

Health impact information is taken from the Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable health care expenditures are based on 2004 smoking-attributable fractions and 2009 personal health care expenditure data. Deaths and expenditures should not be compared by state.